Basic Information
| Provider Information | |||||||||
| NPI: | 1548225576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029696552 | ||||||||
| FaxNumber: | 5022121358 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 E BROADWAY | ||||||||
| Address2: | STE 195 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026294263 | ||||||||
| FaxNumber: | 5026294282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 07/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 32802 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 32802 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200822720 | 01 | KY | HEALTHY INDIANA PLAN- LOUISVILLE ARM AND HAND | OTHER | 64119571 | 05 | KY | MEDICAID | 000000507566 | 01 | KY | ANTHEM - LAH | OTHER | 069472 | 01 | KY | SIHO - LAH | OTHER | 2808156000 | 01 | KY | PASSPORT ADVANTAGE - LAH | OTHER | 50013626 | 01 | KY | PASSPORT - LAH | OTHER | P00365516 | 01 | KY | RAILROAD MEDICARE | OTHER | 000023025U | 01 | KY | HUAMANA - L:AH | OTHER | 200822720 | 05 | IN | MEDICAID |